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Nurse Staffing Ratios Would Harm Cambridge Health Alliance

As the Chair of the Board of Trustees at Cambridge Health Alliance (CHA), a health system that serves more than 140,000 patients in Cambridge, Somerville, Everett, Malden and Revere, I am writing to express concerns about Question 1, the government-mandated nurse staffing ratio proposal on the November ballot. If approved, this mandate would negatively impact access to care and services at CHA hospitals and primary care centers in Everett and the surrounding communities.

Question 1 would threaten access to emergency services, increase wait times and force patients to seek care elsewhere. The law would prevent us from being able to effectively manage a surge in patients in our emergency departments, leaving patients waiting in our reception areas.

The mandate endangers CHA’s unique role in behavioral health care for patients at a time when it is needed most in light of the opioid crisis. It would limit access to inpatient behavioral health care, cause delays and barriers to care for other vital behavioral health services and put a vulnerable population at risk. Ratios are not consistent with behavioral health clinical standards of care and overlook the wide range of clinicians and staff members on our care teams, including social workers and counselors.

Health care staffing is dynamic, and our nurses make decisions at our patients’ bedside based on a wide range of factors including individual patient needs and care team skills. If there is a crisis or emergency, nurses need the flexibility to jump in and help without fear of breaking the law. This proposal would override their clinical judgment and expertise.

Ratios would also threaten CHA’s financial stability. An October 3rd report from the Massachusetts Health Policy Commission, an independent state agency, estimated that the mandate would cost Mass. hospitals up to $949 million to implement. In particular, the Commission flagged the potential impacts on community hospitals, especially those, like CHA, that serve higher percentages of publicly insured patients. The report validates our concerns that the high costs of ratio would damage our mission to serve all patients.

In a time when access to care is more important than ever, we fear this proposal would harm CHA’s ability to provide that access and jeopardize critical services delivered to our communities.

Joshua Posner is Chair of the Board of Trustees of Cambridge Health Alliance (CHA), a Harvard-affiliated community health system that serves more than 140,000 patients in Cambridge, Somerville, Everett and Boston’s metro-north region. The CHA Board of Trustees is comprised of volunteer community members from Cambridge Health Alliance’s primary service area.